Conservative treatment in major kidney trauma

The kidney is frequently involved in penetrating abdominal injuries, and less so in closed abdominal traumatism. This paper presents one case of major renal trauma with total renal fracture and development of urinoma that separated both segments that, after a minimally invasive manoeuvre (percutaneous drainage), evolved favourably thus avoiding a surgical procedure which, quite reasonably, would have led to nephrectomy.     

Immediate results of surgical treatment of gastric stump cancer

An immediate result of surgical treatment of gastric stump cancer in 68 patients is presented. The resectability rate was 23.5%. Lethality after radical operations was 18.7%, after symptomatic operations and exploratory laparotomy-9.6%. Gastric resection was performed, using the method developed in the clinic with wrapping the anastomosis, or gastric stump by a loop of the afferent intestine. In development of gastric stump cancer, local spreading of a tumor is not a reason to discard performance of radical operation.     

The diagnosis and treatment of blunt renal trauma

225 patient with blunt renal trauma were treated from 1955 to 1994. Coexistent injuries of other organs were noted in 79 patients (35.11%). The extent of renal trauma was not demonstrated by hematuria. B-ultrasonography seemed to be best for the diagnosis of renal trauma. Abdominal incision was helpful to explore injuries of other organs and manage renal trauma. Early treatment of renal trauma was necessary for the treatment of shock and prevention of serious complication.     

Immediate orthopedic surgery in multiple trauma

The increase in mortality and morbidity from multiple trauma due to road accidents, industrial trauma and combat injuries obligates treatment based on emergency systems and trauma centers. Follow-up of the frequency of different types of injury calls attention to increasing involvement of the orthopedic surgeon in primary treatment. This situation calls for appropriate deployment of immediate surgical treatment which will rapidly enable mobility. We present several methods for immediate orthopedic treatment of multiple-trauma patients.     

Biomechanical analysis and clinical treatment of blunt renal trauma

Moesin, one of the ERM (ezrin; radixin; moesin) family members, is directly associated with the cytoplasmic domain of CD44, which is now thought to be related to the metastatic potential of tumor cells. Using immunohistochemistry we investigated the expression of moesin in normal epidermis and various kinds of epithelial skin tumors: squamous cell carcinoma, verrucous carcinoma, Bowen's disease, solar keratosis, keratoacanthoma, basal cell carcinoma, and extramammary Paget's disease. Normal skin showed positive epidermal staining for moesin with the exception of the stratum corneum. The expression of moesin varied with the type of skin tumor. In basal cell carcinoma, Bowen's disease, and extramammary Paget's disease, moesin expression was either faint or negative. In contrast to Bowen's disease, invasive squamous cell carcinoma showed more intense and heterogeneous staining of the cytoplasm and the cell membrane. Verrucous carcinoma was weakly positive, with a tendency for the moesin to be distributed in the cell membrane. The staining pattern of moesin varied among the different kinds of epithelial skin tumors, and its expression was generally similar to that of the standard form of CD44. These results suggest that moesin is closely inter-related with CD44 in epithelial skin cells as seen in other cellular systems, and that the variable pattern of moesin staining among the skin tumor cells could reflect expression disorders associated with the transformation.     

Ipsilateral adrenalectomy in the surgical treatment of renal carcinoma

OBJECTIVES: To assess the value of ipsilateral adrenalectomy during radical nephrectomy for the treatment of renal cell carcinoma as a function of preoperative computed tomography findings. METHODS: Between May 1985 and June 1994, 194 patients underwent radical nephrectomy for renal cell carcinoma in our institution. Preoperative radiological reports and postoperative pathological reports were reviewed for 185 patients. RESULTS: 148 patients underwent abdominal computed tomography before surgery. 94 adrenalectomies were performed in this group of patients. None of the 77 patients in whom computed tomography showed a normal adrenal gland had adrenal metastasis on the definitive histological examination. 17 patients had an adrenal mass on computed tomography, 3 of which proved to be neoplastic. Preoperative CT had a sensitivity of 100%, a specificity of 82%, a positive predictive value of 18% and a negative predictive value of 100%. The 185 files reviewed included 114 adrenalectomies, including 4 adrenal glands invaded by renal cell carcinoma (3.5%). In these 4 cases, the smallest diameter of the renal tumour was 4 cm and the minimum pathological stage was T3. CONCLUSIONS: It therefore appears justified not to perform adrenalectomy during nephrectomy, in the presence of a renal tumour and negative adrenal computed tomography.     

Closed renal trauma

A series of 76 cases of closed renal trauma is presented. The clinical and radiological features are described and the indications for conservative and surgical treatment discussed.     

Results of the conservative treatment of severe renal trauma in childhood

Surgical treatment of severe renal trauma usually ends in loss of high percentage of kidneys. In consequence of this, in the last decade several authors prefer a conservative management of kidneys severely injured. There include stabilization in Intensive Care Unit, with the goal of preservation the most possible functioning renal tissue. The purpose of this paper is to present the results of conservative management of severe renal trauma in our Center in the last five years. We conclude that this type of management is accurate and effective.     

Nonoperative treatment of major blunt renal lacerations with urinary extravasation

PURPOSE: We determined whether nonoperative treatment of major renal lacerations with urinary extravasation adversely affects patient outcome. MATERIALS AND METHODS: We reviewed all nonoperatively treated patients who presented between 1983 and 1994 with blunt renal trauma with major lacerations on initial staging computerized tomography. Patients with major lacerations associated with (31) and without (15) extravasation were compared for complications, blood transfusions and length of hospital stay. RESULTS: Urinary extravasation spontaneously resolved in 27 of 31 patients (87.1%), while 4 (12.9%) required a ureteral stent for persistent extravasation. No complications occurred in patients without extravasation. Mean hospitalization was 8.3 and 7.7 days for patients with isolated renal injuries with and without extravasation, respectively. Blood transfusions were required in 4 patients with and none without extravasation. CONCLUSIONS: Nonoperative treatment of major renal lacerations with urinary extravasation is safe and effective. Although delayed intervention may be required, complications can often be treated with endourological or percutaneous methods.     

Prevention and treatment of renal insufficiency in patients with severe cranio-cerebral trauma

In 147 patients with severe craniocerebral injuries the functional state of the kidneys was examined. The incidence and peculiarities of renal function disorders were studied in such patients. A table is presented for the assessment of the degree of renal function disorders by the values of glomerular filtration and the level of nitrous products in blood. On the basis of the author's personal experience measures of prevention and treatment of renal failure in such cases are described.     

Epidemiology of major trauma and trauma deaths in Los Angeles County

The aims of this study were to identify differences in the centre of buoyancy (CB) and centre of mass (CM) locations of male and female collegiate swimmers, and to assess the influence that buoyancy has on freestyle kicking performance. Sixteen female collegiate swimmers (mean +/- s: age 19.1 +/- 1.2 years) had significantly more adipose tissue (20.2 +/- 4.4%) than 15 male collegiate swimmers (19.9 +/- 1.0 years, 12.6 +/- 3.8%). The ratio of the sum of abdominal and suprailiac skinfolds to the thigh skinfold was significantly greater for the males (2.07 +/- 0.37) than the females (1.31 +/- 0.32), implying that females had proportionately more fatty tissue caudally than males. The distance d between the centres of buoyancy and mass was significantly larger for the males (0.79 +/- 0.43 cm) than the females (0.16 +/- 0.34 cm). Both points were more caudal in the female subjects (59.9 +/- 0.7% and 59.8 +/- 0.7% of body height respectively) than in the male subjects (61.7 +/- 0.8% and 61.2 +/- 0.9% respectively). These data suggest that the difference in d may be attributed to the difference in the location of the centre of buoyancy, because the centre of mass difference was not significant and was characterized by a smaller effect size. The amount and distribution of adipose tissue accounted for a significant proportion of variance in d (R2 = 0.25 and 0.29 respectively). Males had a significantly higher proportional kick time, defined as the ratio of times to complete a 22.9 m sprint when kicking and swimming respectively, than females (1.57 +/- 0.09 and 1.51 +/- 0.13 respectively). This shows that the male swimmers kicked proportionally more slowly than the female swimmers. However, the distance d did not account for a significant proportion of variance in the proportional kick time. Therefore, our results do not support the notion that skilled male swimmers are at a performance disadvantage in terms of natural buoyancy characteristics.     

Immediate and late results of the surgical treatment of the aneurysms and dissections of the ascending aorta

Cyclosporine (CsA) and some of its metabolites (M9, M17, M18, M21) have been determined by means of an LC-MASS method in eight psoriatic patients developing nephrotoxicity. In comparison with a control group (15 psoriatics who after the same period of time, with the same daily dose, did not develop nephrotoxicity) they showed an increase of CsA metabolites, especially M17. Because M17 blood concentrations in the nephrotoxic group tended to be higher than in the control group from the first week of treatment we suggest that M17 might be considered a marker of ongoing nephrotoxicity.     

Evaluation and management of pediatric major trauma

Proper management of the pediatric trauma patient involves most of the components contained within standard trauma protocols. By paying strict attention to the anatomical and physiological differences among the pediatric population, the clinician will be assured the best outcomes. This article outlines the fundamentals of proper management of pediatric trauma patients.     

Clinical studies on renal trauma

A total of 18 kidneys in 17 patients with renal trauma were treated at the Department of Urology, Mitoyo General Hospital between April 1991 and August 1997. Patients were between 10 and 88 years old (median; 52). Eleven of them were male and 6 were female. The main cause of injury was a traffic accident in 11 cases (64.7%), which was similar in tendency to previous reports in this country. According to the Classification of Renal Injury by the Japanese Association for the Surgery of Trauma in Japan, there were 8 cases (47.1%) of Type I (sub-capsular injury) and Type II (superficial injury) that was classified a minor injury, and there were 9 cases (52.9%) of Type III (deep injury), Type IV (pedicle injury) and open injury that was classified as a major injury. Surgical treatment was performed in 8 cases (47.1%), which were all classified as a major injury. Posttraumatic plasma lactate dehydrogenase (LDH) was elevated immediately in case of major injury in comparison with a case of minor injury. Serum LDH may be useful as a parameter of the degree of renal trauma.     

Preoperative management of patients with major trauma injuries

Traumatic injuries require rapid, efficient, and precise diagnose and immediate treatment. Patients with major trauma injuries place special demands on emergency department, OR, and intensive care unit health care providers. Cost-effective and time-efficient management of these patients results in improved patient care and optimal outcomes in this era of shrinking health care dollars. Perioperative nurses need to be aware of the many evolving changes in the preoperative management of patients with major trauma injuries to provide quality care to these patients.     

Immediate recovery from acute renal insufficiency after abdominal decompression

A 61-year-old man received an aorto-iliac reconstruction after he was admitted because of a ruptured abdominal aortic aneurysm. Postoperatively, he developed cardiopulmonary insufficiency with anuria. After the intra-abdominal pressure had risen to 40 cmH2O (measured by a urinary bladder catheter), it was decided to perform a relaparotomy. Immediately after abdominal decompression--without correction of any other intra-abdominal pathology--the diuresis increased and several other cardiopulmonary parameters improved significantly. When a critically ill patient shows a rapid increase of the intra-abdominal pressure above a critical level an acute abdominal compartment syndrome may develop. This syndrome consists mainly of potentially fatal cardiopulmonary and renal insufficiency, for which (re)laparotomy with abdominal decompression is the only correct treatment.     

The surgical treatment of renal artery fibrodysplasia. The immediate and late results

Between November 1977 and April 1992, thirty patients carrying several forms of renal artery fibrodysplasia underwent surgical treatment. The series is composed of thirteen male and seventeen female, aged between 1 and 51 years (mean age 32). All patients had arterial hypertension, which was not relieved by medical therapy, consisting in the administration of an average of 2.9 antihypertensive drugs per patients. Bilateral renal artery lesions were diagnosed in ten patients (33.3%). The remaining twenty patients (66.6%) had unilateral lesions, one of which involved a congenital single kidney, making a total of forty renal arteries affected by the disease. Surgical procedures consisted in renal artery revascularization in thirty-one kidneys, in aneurysmectomy alone or associated with aorto-renal bypass in six cases, and in a nephrectomy as a single procedure in one case. Three kidneys were considered lost and were left untouched. There was no operative mortality. Evaluated between 1 and 173 months following the operation (mean 79 months/6.6 years) twenty-six patients (86.6%) were classified as either cured or improved. Only two patients (6.6%) did not get any improvement with the surgical treatment. Two patients whose condition after the operation was considered satisfactory were lost to follow-up. The results of this experience are compared with other series published in the international literature, as well as with the percutaneous transluminal angioplasty which has been regarded as an alternative to arterial reconstructive surgery.